From East Timor Diplomat, to Arnhem Land project officer, to non-fiction writer – UNSW med student Tanya has seen it all!

Tanya Burke has already seen and done more than most people do in a lifetime. It was as a diplomat in East Timor when she first discovered her love of medicine, working alongside the Australian Embassy doctor – and she carried that passion onto her work on a scabies program in East Arnhem Land, where she co-authored a book about her experiences there.

Now Tanya – who is from Hernani (located between Armidale and Coffs Harbour) – has kicked off her first year of medicine, and is realising her ultimate dream of being a doctor. Tanya, who is a rural medicine student, tells us more:

Can you tell us about your experience working as a diplomat in East Timor, and how it inspired you to change tack with your career, and study medicine?

I was posted to Timor Leste (East Timor) just as the UN were pulling out after the country achieved independence.

They were golden years in Timor Leste, full of optimism despite a devastated infrastructure and utterly basic living conditions. There was an Australian doctor there, Doctor Dan, who was an institution. He is still there (UNSW students sometimes train with him!), and while I was there the Timor Leste government organised for a team of Cuban doctors to come over.

There were also some Indonesian doctors, and Australian specialists who regularly travelled to Timor to fill in some of the gaps. One of my staff members had tears in his eyes when he showed me photos of his baby girl after an Australian plastic surgeon had repaired her cleft palate. It was a hopeful, inspiring time.

All over the country people were communicating in a mix of languages - local languages, Tetum, Indonesian, Portuguese, sometimes English and smatterings of the languages brought in with all the foreigners. Everyone was working hard to get the country back on its feet and make life better.

The Australian Embassy doctor sometimes travelled with me on projects, and when I noticed how much misinformation there was about women's reproductive issues I asked him to come in for an afternoon to talk to the female embassy staff. There was very little access to computers or the internet at that time, and electricity was hit and miss, so finding reliable information about female reproductive issues was difficult and all kinds of rumours and old-wives-tales abounded, along with unsafe abortions, one of the world's highest fertility rates and a very high infant and child mortality rate.

Access to reliable information about their own bodies was an essential beginning - women were having an average of eight children, often spaced very close together and malnutrition was endemic. And Timor Leste was a place where community was very strong. Information, right or wrong, spread throughout networks very efficiently. The first First Lady, another Australian (Kirsty Sword Gusmao) took advantage of this with her NGO, Fundasaun Alola, which used a sophisticated pass-it-on system to educate and encourage women to breastfeed their babies as there were ideas circulating at the time that breast milk was dirty and unsafe.

My own job as Vice Consul and political secretary was to report on political, economic and security issues and take care of Australians who got into trouble in Timor Leste. It was a fascinating job that could take me to talk to the President in the morning, show the Governor General around at lunchtime, visit an Australian in jail in the afternoon and fly classified reports to Darwin in the evening.

But what I fell in love with was understanding how people tick. Especially the people in jail, in the police lock-up, in the hospital and being extradited. What got these people into their predicaments?

Can you tell us about your time in East Arnhem Land working on the scabies program?

In East Arnhem Land there was also a need for better information. Scabies is a mite that burrows under the skin and causes an intense itch. Up to seven out of ten children got scabies by the age of one in some areas and it kept them up at night with the itch and pain. They tended to scratch themselves raw and in the tropics this almost inevitably resulted in strep infections. Chronic strep infections can lead to rheumatic fever and we have the world's highest rates of rheumatic heart disease in some parts of Australia. We were seeing young men and women struck down by heart failure before they had even left their teens.

One of the myths about scabies was that if people would clean properly they could be scabies-free. But we found that there were one or two people in each community who had a neglected disease called Crusted Scabies that acted like an amplifier. For most people the scabies mite would establish an equilibrium population but for these people the mite would just keep reproducing until they were covered in millions of mites and crusts of dead skin. People with crusted scabies pick up the scabies mite more easily than other people, and because it doesn't reach an equilibrium, they shed the mite everywhere they go. They are like a furnace blasting scabies out into the community.

So rather than tell people to clean better, we worked with local clinics and communities, helping people with Crusted Scabies manage what was really a chronic disease. And we saw their lives change, the lives of their families improved and whole communities were better able to manage scabies. One of our patients asked us to try and stop the treadmill of shame and blame happening to other patients. It is true that overcrowded living conditions make the problem worse, but no amount of cleaning could stop these few people from being susceptible to the scabies mite. Dr Lokuge, managing the project, was able to change the treatment guidelines so that all remote clinics now have access to the chronic-care approach to Crusted Scabies.

At the time my children were between four and eight years old, and I home schooled them most of the time we were up there. They loved jumping off an old tree into a billabong with the ‘Black As’ boys, gathering mudcrabs with an old grandma and collecting bark so that they could paint with some of the families.

While we were there the ‘Black As’ boys asked for help to put on a TV show and so we approached the ABC and David Batty to help out and they've just got their first series of webisodes up on iview - so if you want to see what life in Arnhem Land is like you can now watch it for yourself! :)

Can you elaborate more on this line: what really inspired me was the desperate need for improved access to metal health care services in rural and remote areas.

In Arnhem Land I met a few people in need of mental health support, and unlike the bigger cities, there was just no support available. Just like the people with crusted scabies, quietly and hopelessly suffering their condition when there were effective treatments available, people who deal with mental health issues in many parts of Australia are more or less on their own. I decided I wanted to be able to provide that support, not just to patients but also to GPs, remote clinics, first-line responders in schools, community organisations and hospitals so that when people suffer with mental health problems, they can find someone to help them.

Mental health is a complex social problem that starts, like all health, in utero, and it won't be fixed by individual doctors or hospitals but I've lived in rural and remote places most of my life and I know how isolating it can be. I think there are some tweaks we can make, just as we did when treating the crusted scabies patients, and when we provided education to women on reproductive issues and breastfeeding, that can have big impacts in mental health, and that's the area I want to work in.

What was it like writing your book, and how does that fit into the above picture?

I love writing so it was fun to write. To some extent the publisher was interested in making the story as sensational as possible, but we didn't want there to be good guys and bad guys. What we saw in Arnhem Land was a whole lot of amazing people, Indigenous and non-Indigenous, working hard to make life better and often becoming frustrated because some of the problems seemed intractable. Sometimes this was because of misinformation, sometimes because of a broken system and sometimes because of cultural differences and cross-purposes.

So one of the messages we wanted to convey was that this Hollywood hero mind-set of the knight in shining armour coming to fix things is really not appropriate. We have to drop that narrative and learn together, accepting that people must have the agency to define their own problems before we can even begin to consider solutions.

It has been said that the first Australians were the ultimate diplomats, that they ran the only continent on earth without land wars, for millennia. In one community I worked in there was a law that speaking on behalf of someone else without their permission was a punishable offense, in some cases by death. And you needed to have specific permission on each topic. This was exactly how it was for me as a diplomat (though luckily there is no death penalty here now), I had in my head a mix of everyone-knows-that-stuff right through to only-two-other-people-know-this-Top-Secret-stuff and I had to know exactly who could hear what bits of that information or I could get myself into a lot of trouble.

So this idea that only you have the right to speak for yourself made sense to me, it prevents a lot of misunderstanding and misrepresentation and it is reflected in our ideas of informed consent and patient confidentiality.

But our thoughts, feelings, opinions, memories, relationships and understandings of the world are not covered in our medical/legal/financial model of the world. There is so much more to learn about the human being, especially what it is that gets us into our strange and wonderful predicaments, and there's no knight in shining armour, just a whole lot of amazing people working hard to make life better. It is exciting to be a part of that.